Provider Demographics
NPI:1629201769
Name:DIANE GALPER AND ASSOCIATES OD PC
Entity type:Organization
Organization Name:DIANE GALPER AND ASSOCIATES OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-380-3900
Mailing Address - Street 1:27800 NOVI RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3031
Mailing Address - Country:US
Mailing Address - Phone:248-380-3900
Mailing Address - Fax:248-380-3965
Practice Address - Street 1:27800 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3031
Practice Address - Country:US
Practice Address - Phone:248-380-3900
Practice Address - Fax:248-380-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4627Medicare PIN
MI1090230001Medicare NSC